BACKGROUND

Esophageal cancer is a serious global health concern with poor prognosis in advanced stages. Immune checkpoint inhibitors (ICIs) have shown promise in enhancing survival, but they are associated with immune-related adverse events, including potentially life-threatening myocarditis. Moreover, ICI-induced myocarditis can be asymptomatic, necessitating early diagnosis. Specific risk factors and biomarkers for esophageal cancer remain poorly characterized.

AIM

To investigate the determinants of ICI-associated asymptomatic myocarditis in patients with esophageal cancer and explore potential early biomarkers.

METHODS

A retrospective analysis was conducted on 202 cancer patients who received treatment at Shanxi Province Cancer Hospital from July 2019 to July 2024.

RESULTS

Older age, male gender, and elevated creatine kinase isoenzymes (CK-MB) and CK levels were found to be significant risk factors for asymptomatic myocarditis. The myocarditis occurrence group had higher CK-MB (3.05 ng/mL 5.02 ng/mL; < 0.001) and CK levels (187.29 U/L 212.25 U/L; = 0.005), and the predictive value of age, gender, CK, and CK-MB was low [are under the receiver operating characteristic curve (AUC) = 0.579-0.608]. However, their combination in a predictive model showed improved diagnostic capability, with an AUC of 0.808.

CONCLUSION

Age, gender, and cardiac biomarker levels considerably contribute to the risk of ICI-related myocarditis in patients with esophageal cancer. The integration of these factors into a predictive model enhances early diagnosis, facilitating personalized risk management.